Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
Department of Anesthesia and Perioperative Medicine, University of Massachusetts Medical School, Worcester, Mass.
J Vasc Surg. 2020 Nov;72(5):1576-1583. doi: 10.1016/j.jvs.2020.02.013. Epub 2020 Apr 2.
Lumbar drain placement with cerebrospinal fluid (CSF) drainage is an effective adjunct for reducing the risk of spinal cord ischemia in patients undergoing complex aortic aneurysm repair. However, lumbar drain placement is a challenging procedure with potential for significant complications. We sought to characterize complications of lumbar drain placement in a large, single-center experience of patients who underwent fenestrated or branched endovascular aneurysm repair (F/BEVAR).
All patients who underwent F/BEVAR and attempted lumbar drain placement from 2010 to 2019 were retrospectively reviewed. All lumbar drains were placed by four cardiovascular anesthesiologists who compose the complex aortic anesthesia team. Lumbar drain placement was guided by a set protocol and used whenever the aortic stent graft coverage was planned to extend more proximal than 40 mm above the celiac artery. Details relating to lumbar drain placement, management, and frequency and type of associated complications were characterized.
During the study period, 256 patients underwent F/BEVAR, of whom 100 (39%) were planned for lumbar drain placement. Successful placement occurred in 98 (98%) of the cases. All lumbar drains were placed before induction of general anesthesia, using fluoroscopy guidance in 28 cases (28%). The most common level of placement was L4-5 (n = 42 [42%]). The majority (n = 82 [82%]) were left in place ≤48 hours; 21% were removed during the first 24 hours, and 61% were removed between 24 and 48 hours. Nonfunctionality was the most common complication, occurring in 16 (16%) patients. Catheter dislodgment or fracture, CSF leak, and postdural puncture headache were observed in 4 (4%), 7 (7%), and 4 (4%) patients, respectively. The most common bleeding complication was the presence of asymptomatic blood in the CSF (n = 11 [11%]), whereas subarachnoid hemorrhage combined with intraventricular hemorrhage occurred in three patients (3%); none of these patients required surgical drainage or intervention. No infectious complications were observed.
Lumbar drain placement for CSF drainage is a commonly employed adjunct to prevent spinal cord ischemia in F/BEVAR. Our experience demonstrates that lumbar drain placement can be performed successfully but is associated with a significant rate of nonfunctionality and a diverse range of complications that, fortunately, do not commonly have significant long-term sequelae.
在接受复杂主动脉瘤修复的患者中，放置带脑脊液（CSF）引流的腰椎引流管是降低脊髓缺血风险的有效辅助手段。然而，腰椎引流管的放置是一项具有挑战性的操作，可能会出现严重的并发症。我们旨在描述在接受开窗或分支型血管内动脉瘤修复（F/BEVAR）的大量单中心患者中，腰椎引流管放置的并发症特征。
回顾性分析 2010 年至 2019 年期间接受 F/BEVAR 并尝试放置腰椎引流管的所有患者。所有腰椎引流管均由四位组成复杂主动脉麻醉团队的心血管麻醉医师放置。腰椎引流管的放置遵循一套既定的方案，只要主动脉支架移植物的覆盖范围计划超过腹腔干上方 40mm 以上，就会使用。描述了与腰椎引流管放置、管理以及相关并发症的频率和类型相关的详细信息。
在研究期间，256 例患者接受了 F/BEVAR，其中 100 例（39%）计划放置腰椎引流管。98 例（98%）成功放置。所有腰椎引流管均在全身麻醉诱导前放置，28 例（28%）使用透视引导。最常见的放置部位是 L4-5（n=42[42%]）。大多数（n=82[82%]）在≤48 小时内留置；21%在 24 小时内取出，61%在 24 至 48 小时内取出。最常见的并发症是无功能，发生于 16 例（16%）患者中。4 例（4%）患者出现导管移位或断裂，7 例（7%）患者出现脑脊液漏，4 例（4%）患者出现硬脊膜穿刺后头痛。最常见的出血并发症是脑脊液中有无症状性血液（n=11[11%]），3 例患者出现蛛网膜下腔出血合并脑室出血（3%）；这些患者均无需手术引流或干预。未观察到感染性并发症。
在 F/BEVAR 中，放置腰椎引流管以引流 CSF 是预防脊髓缺血的常用辅助手段。我们的经验表明，腰椎引流管的放置可以成功进行，但会导致很高的无功能发生率，并出现多种并发症，但幸运的是，这些并发症通常不会产生严重的长期后果。
